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Can’t Swallow a Pill? There’s Help for That

Ever since she was a child, Karen Quinn has had a terrible time swallowing pills. It doesn’t matter if it is a vitamin or an aspirin. The pill inevitably lodges in her throat, and she panics.

“I choke on anything bigger than a raisin,” said Ms. Quinn, who runs a test preparation service for children. “If I want to take a ‘grown-up’ vitamin, I have to open up a capsule and pour it on my oatmeal, which kind of ruins the oatmeal. So I take as many gummy vitamins as I can.”

“Age doesn’t really impact your ability to swallow a pill,” said the lead author, Dr. Kathleen Bradford, a professor of pediatrics at the University of North Carolina at Chapel Hill. “A teenager can have just as many problems as a 5-year-old. It likely has to do with anxiety and the negative associations with swallowing a pill.”

Many never outgrow the problem. Harris Interactive reported that 40 percent of American adults have difficulty swallowing pills, even though most have no problems with food or liquids. Eighty percent said they did not like the feeling of having a pill stuck in their throat, 48 percent said pills caused a bad aftertaste, and 32 percent said pills caused them to gag. A study of 1,051 adults in The European Journal of Clinical Pharmacology produced similar numbers: 30 percent had difficulty swallowing pills, and almost 10 percent stopped taking the medications as a result.

“A pill is a solid substance,” said Leanne Goldberg, a speech and language pathologist at Mount Sinai Hospital in New York who specializes in treating swallowing and voice disorders. “We learned that we have to chew something that is solid. It takes a mental shift to relax the throat and be able to swallow something that we fear could cause us to choke.”

While some medications can be taken in liquid form or crushed, time-release medications and those with certain coatings cannot be crushed.

“Each person that has difficulty has different reasons,” Ms. Goldberg said. “Sometimes, it’s a very sick patient that has to take a lot of medication and it’s how they manifest their emotions. Another might have a fear or anxiety of choking. And yet another might have a hypersensitive gag reflex.”

Other physiological reasons may include gastroesophageal reflux disease (GERD); scleroderma, a scarlike tissue buildup that can weaken the lower esophageal ring; and an aversion to the taste of pills. “Emotional or anxiety issues, generally stemming from a past experience, may also factor in,” she said.

The dislike for swallowing pills does not apply only to medication, which is one reason alternate delivery methods of vitamins and supplements — sprays, powders, chews and liquids — have gained popularity.

The authors of the Pediatrics study, who reviewed research on pill swallowing, determined that various techniques — behavioral therapy, specialized pill cups, flavored throat spray, verbal instruction and head posture training — can help children as young as 4 swallow easier. It could also help adults.

A child might experiment, for example, with putting juice or water in his or her mouth first, followed by the pill — or the other way around. With younger children, guided imagery also may help, such as imagining that the tongue is a water slide, the pill is the rider, and the pill rides the water slide into the pool (stomach), Dr. Bradford said.

Specialized pill-swallowing cups, sold in pharmacies and online, help the user “drink” a pill — the cup is filled with fluid, and the pill is placed in a reservoir so the liquid and the pill mix in the mouth.

A 2014 study of 151 adults up to age 85, published in The Annals of Family Medicine, reported that the so-called pop bottle method can work with larger tablets. The tablet is placed on the tongue, the lips are tightly closed around the opening of a plastic bottle, and “the tablet is swallowed in a swift suction movement to overcome the volitional phase of swallowing,” the authors write. The “lean forward” approach works with capsule avoiders: Place the capsule on your tongue, take a medium sip of water and tilt your chin forward while swallowing.

The researchers did not test these methods on children, but “there is no reason to believe that it might not work, because the physical properties of the pills are obviously independent of the age of the patient,” the lead author, Dr. Walter E. Haefeli, the head of the department of clinical pharmacology and pharmacoepidemiology at Heidelberg University Hospital in Germany, said in an email.

Dr. Altmann instructs patients to roll up a Tic Tac-size piece of bread and swallow it — a technique she devised as a child to help herself take pills. “Mentally, you know that bread is soft, not hard, so it doesn’t seem as scary to gulp down,” she said. She then has patients gradually increase the size of the bread until it is equivalent to an M&M. (This method also works with candy, beginning with Nerds and working your way up to a Good & Plenty — one of the few times doctors sanction eating candy.)

One final option: giving patients liquid medication instead of a pill, especially a liquid that tastes terrible. “If it tastes so horrible that they can’t get it down, sometimes that’s enough motivation to swallow the pill,” she said.